AUCTORES
Globalize your Research
Chat with us
Case Report | DOI: https://doi.org/10.31579/2693-4779/097
1 Clinic for Pediatric Surgery, Clinical Center of the University of Sarajevo.
2 Department of Surgical Diseases - Cantonal Hospital Zenica.
3 Surgical Diseases, Tešanj General Hospital.
4 Clinic for Anesthesia and Reanimation, Clinical Center of the University of Sarajevo.
5 Oceania University of Medicine, Melbourne, Australia.
*Corresponding Author: K. Karavdić, Clinic for Pediatric Surgery, Clinical Center of the University of Sarajevo.
Citation: K. Karavdić, A. Firdus, Mulahalilović A, Đogić H, Altunbabić L, Dewan P.A. (2022) Combined Extraction (Cystourethroscopy and Suprapubic Cystotomy) of A Selfinserted Hairpin Located In The Posterior Urethra - A 7-Year-Old Boy. Clinical Research and Clinical Trials. 6(1); DOI: 10.31579/2693-4779/097
Copyright: © 2022 K. Karavdić. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Received: 25 April 2022 | Accepted: 06 May 2022 | Published: 16 May 2022
Keywords: hairpin; urethra; cystourethroscopy; suprapubic
Self-inserted urethrovesical foreign bodies are rare in children. A 7-year-old boy inserted a hairpin into the urethra seven days before admission, a diagnosis that was made on the basis of the appearance of blood in the urine, palpation of the base of the penis and two directional X-ray imaging. Cystourethroscopy and suprapubic cystotomy were used to remove the foreign body.The presentation of urethrovesical foreign bodies can vary widely, as can the type of object inserted. Definitive treatment is usually the endoscopic removal, however occasionally surgical intervention may be required. Our novel approach enabled less traumatic removal of the hairpin
Self-inserted intra-vesical and intra-urethral foreign bodies are rare emergencies in Pediatric Urology, although there has been an increase in reports in the last few decades [1]. Previous studies have reported several different inserted items which were found in the urethra and/or the urinary bladder including sharp and lacerating, wire-like objects objects [2]. Most of the intravesical foreign bodies are the result of self-introduction, but they can also result from medical procedures, migration from the surrounding organs or penetrating injuries. In self-introduced foreign bodies, most patients feel embarrassed, tend to postpone medical help and present to a tertiary institution after multiple removal attempts, which risk urethral injury and foreign body migration. Here-in we present a case of a foreign body in the urethra, and we discuss the clinical presentation, diagnosis and management of patient.
A seven-year-old boy was admitted to the emergency department in a regional hospital. The patient denied symptoms, but his mother noticed blood in his underwear. The mother said that the boy complained of dysuric problems, the appearance of blood when urinating, as well as the appearance of purulent contents on urethral meatus. The dysuria was reported to have been present for seven days. The boy had not reported inserting an object into his urethra; never-the-less he was intellectually, psychologically and neurologically a normal child, and his mother denied previous similar incidents. The examining pediatrician noted haematuria and prescribed antibiotics, despite which the symptoms worsened, and the patient reported to the pediatric surgery unit in the regional hospital. Posterio-anterior and lateral X-rays of his pelvis showed a radio-opaque foreign body consistent with a hairpin-shaped structure, located in the regions of the penis.(figure 1,2).
An attempt to remove the hairpin in the regional centre failed, and he was transferred to our clinic, where he was noted to have blood at the urethral meatus.
At the base of the penis was a firm smooth-edged painful mass At urethroscopy a hairpin was observed in his bulbar urethra, which was swollen and hyperaemic. The sharp end of the hairpin, located in the penile urethra, faced distally and was firmly driven into the inflamed mucosa of the urethra. Thus, was unable to extrated throught the meatus. Therefore, the hairpin was pushed into the bladder, facilitated by the blunt end facing toward the bladder. (figure 3,4,5).
After the hairpin was pushed retrogradely into the bladder, transurethral mobilization from the hairpin into the urinary bladder, the bladder was filled with saline, and a 5 mm suprapubic extraperitoneal laparoscopic trocar inserted into overfilled bladder, under transurethral cystoscopic vision. Thus transvesical extraction was achieved through the suprapubic trocar with a 5 mm grasper.(figure 6) A catheter was inserted, and remained for 8 days, after which he made a good recovery.(figure 7).
Foreign body insertion into the Paediatric lower urinary tract occurs infrequently, with a male to female ratio of two to one. (3) However, females are at an increased risk for foreign body migration into the bladder, due to short urethral length, and straight trajectory of the female urethra. Self-introduction of the foreign bodies is rarely seen in young children [4], generally occurring early in the puberty, as for our case.
The explanation for self-insertion of foreign bodies often reflects psychiatric disorders, accidental insertions, seeking sexual stimulation, attention seeking behaviour, or simple curiosity; most common in patients with psychiatric illness [5].
Urethral and intravesical foreign bodies are important considerations in the differential diagnosis of lower urinary tract symptoms. Clinical presentation may vary from asymptomatic to swelling of external genitalia, lower abdominal pain, dysuria, urethral discomfort, pollakiuria, nocturia, haematuria, bloody or purulent urethral discharge, painful erection, difficulty in voiding, urinary retention. A high index of suspicion is necessary for diagnosis and management of these challenging cases. A urethral foreign body left untreated can lead to serious complications such as urethral stenosis, periurethral abscess, and/or fistula [6].
A high proporation of patients do not admit to the insertion of a foreign object because of embarrassment or mental illness, resulting in the nonspecific symptoms making the diagnose difficult, until imaging is undertaken, as in our case. The resultant delay in diagnosis makes the resultant extraction procedure more difficult, due to inflammatory changes in the urethral mucosa and the possibility of urethral injury with endoscopic manipulation.
Plain-films of the pelvis are generally enough to evaluate number, location, size or orientation of radio-opaque objects for the purposes of treatment planning; computed tomography or ultrasound may be necessary if the object is radio-lucent [7]. Immediate management of patients with a urethral foreign body should be pain relief, control of voiding symptoms with either anticholinergic medication for irritative symptoms, or bladder catheterization if unable to void.
Rahman et al recommends treatment with broad-spectrum antibiotics prior to foreign body removal [8]. Palmer et al recommends empiric coverage for Gram-negative organisms for a duration of 1 week [9]. In case of positive cultures or sepsis, antibiotic coverage should be broadened or tailored as appropriate. Definitive treatment is removal of the foreign bodies with minimal or no urethral morbidity and without compromising erectile function [10]. Choosing the optimal technique for removal of the foreign body is dependent on the patient’s condition and age, urinary tract injuries and the size, shape and material of foreign body. Various methods including meatotomy, cystoscopy, internal or external urethrotomy, suprapubic cystostomy, Fogarty catheterizations and injection of solvents have been used. In cases where endoscopic techniques are unsuitable or unsuccessful, open surgical removal is necessary. For objects lodged in the penile urethra, external urethrostomy is recommended, while a suprapubic cystostomy is the procedure of choice for intravesical foreign bodies; treatment should be individualized according to the particular patient [11].
The first-line treatment is minimally invasive removal by cystoscopy in which the object is grasped and extracted with forceps, graspers, snares or retrieval baskets. Following removal, cystourethroscopy is important to diagnose urothelial injuries and to ensure complete removal of foreign bodies [12]. When the object is visible through the external urethral meatus or is suspected to be small and distally located, gentle manual traction may be applied to try and deliver the object [9]. External urethrotomy has also been described; however, this approach has some potential complications including dehiscence or periurethral abscess secondary to urethral damage should the object is impacted [13]. An undetermined diameter, length or material of the object has been described as contraindication for endoscopic removal. Whenever a surgeon believes that an attempt of endoscopic removal will no doubt result in a traumatic or unsuccessful procedure, the patient should be directly taken for open surgery [14]. In most cases, the formation of multiple knots may preclude safe transurethral removal and some authors have employed suprapubic cystotomy. In the patient of case the decision was made to perform a suprapubic cystotomy to minimize further urethral trauma and expedite extraction. The sharp part of the hairpin was facing toward the outer meatus of the urethra, and had buried itself into the mucosa over a 7 day period, making extraction via the urethra likely to lead to excessive damage to the urethra.
In the circumstance our case there was less risk to the urethra by pushing the blunt end of the hairpin into the bladder, which would obviously be able to be used for other similarly shaped foreign bodies.
Other therapeutic options have been an especially designed magnetic retriever for magnetic extraction of a small metallic intravesical object, such as a hair pin or clip; and the YAG laser has also been used for paraffin and wax objects are frequently reported as foreign intraurethral and intra-vesical objects [2,11] ... previously solvents (xylol, kerosen, benzene) were used to dissolve these objects however, since their known carcinogenic risk, its use is no longer recommended. Endoscopic removal of wax and paraffin is further complicated as these substances tend to float on water, which can be countered by using carbon dioxide insufflation, then removal [15].
Complications following removal of urethral foreign bodies include urethral false passages, mucosa tears with subsequent haemorrhage, urethritis, fistulae, urethral stricture, diverticulum and incontinence. Urethral strictures are the most common delayed complication with a 5% incidence [16]. Therefore, close follow-up of a long duration is advocated to detect delay obstructive symptomatology.
Also, routine Psychiatric/Psychological evaluation should be offered to all patients with intentional foreign body insertion to avoid missing any underlying psychiatric disorders, and because there is a high incidence of recidivism, noting that educating patients about the long-term sequelae is important to try to avoid repeated foreign body insertion [17].
Diagnosis of the existence of a foreign body in the urethra in the pediatric age is a major challenge. Therefore, the diagnosis should be considered in the presence of dysuria and haematuria, and palpation and radiological examination should be considered. When diagnosed, careful consideration should be given to the techniques of removal to ensure minimal secondary urethra injury, which may include retrograde passage of the foreign body and transvesical extraction, as in our case
Clearly Auctoresonline and particularly Psychology and Mental Health Care Journal is dedicated to improving health care services for individuals and populations. The editorial boards' ability to efficiently recognize and share the global importance of health literacy with a variety of stakeholders. Auctoresonline publishing platform can be used to facilitate of optimal client-based services and should be added to health care professionals' repertoire of evidence-based health care resources.
Journal of Clinical Cardiology and Cardiovascular Intervention The submission and review process was adequate. However I think that the publication total value should have been enlightened in early fases. Thank you for all.
Journal of Women Health Care and Issues By the present mail, I want to say thank to you and tour colleagues for facilitating my published article. Specially thank you for the peer review process, support from the editorial office. I appreciate positively the quality of your journal.
Journal of Clinical Research and Reports I would be very delighted to submit my testimonial regarding the reviewer board and the editorial office. The reviewer board were accurate and helpful regarding any modifications for my manuscript. And the editorial office were very helpful and supportive in contacting and monitoring with any update and offering help. It was my pleasure to contribute with your promising Journal and I am looking forward for more collaboration.
We would like to thank the Journal of Thoracic Disease and Cardiothoracic Surgery because of the services they provided us for our articles. The peer-review process was done in a very excellent time manner, and the opinions of the reviewers helped us to improve our manuscript further. The editorial office had an outstanding correspondence with us and guided us in many ways. During a hard time of the pandemic that is affecting every one of us tremendously, the editorial office helped us make everything easier for publishing scientific work. Hope for a more scientific relationship with your Journal.
The peer-review process which consisted high quality queries on the paper. I did answer six reviewers’ questions and comments before the paper was accepted. The support from the editorial office is excellent.
Journal of Neuroscience and Neurological Surgery. I had the experience of publishing a research article recently. The whole process was simple from submission to publication. The reviewers made specific and valuable recommendations and corrections that improved the quality of my publication. I strongly recommend this Journal.
Dr. Katarzyna Byczkowska My testimonial covering: "The peer review process is quick and effective. The support from the editorial office is very professional and friendly. Quality of the Clinical Cardiology and Cardiovascular Interventions is scientific and publishes ground-breaking research on cardiology that is useful for other professionals in the field.
Thank you most sincerely, with regard to the support you have given in relation to the reviewing process and the processing of my article entitled "Large Cell Neuroendocrine Carcinoma of The Prostate Gland: A Review and Update" for publication in your esteemed Journal, Journal of Cancer Research and Cellular Therapeutics". The editorial team has been very supportive.
Testimony of Journal of Clinical Otorhinolaryngology: work with your Reviews has been a educational and constructive experience. The editorial office were very helpful and supportive. It was a pleasure to contribute to your Journal.
Dr. Bernard Terkimbi Utoo, I am happy to publish my scientific work in Journal of Women Health Care and Issues (JWHCI). The manuscript submission was seamless and peer review process was top notch. I was amazed that 4 reviewers worked on the manuscript which made it a highly technical, standard and excellent quality paper. I appreciate the format and consideration for the APC as well as the speed of publication. It is my pleasure to continue with this scientific relationship with the esteem JWHCI.
This is an acknowledgment for peer reviewers, editorial board of Journal of Clinical Research and Reports. They show a lot of consideration for us as publishers for our research article “Evaluation of the different factors associated with side effects of COVID-19 vaccination on medical students, Mutah university, Al-Karak, Jordan”, in a very professional and easy way. This journal is one of outstanding medical journal.
Dear Hao Jiang, to Journal of Nutrition and Food Processing We greatly appreciate the efficient, professional and rapid processing of our paper by your team. If there is anything else we should do, please do not hesitate to let us know. On behalf of my co-authors, we would like to express our great appreciation to editor and reviewers.
As an author who has recently published in the journal "Brain and Neurological Disorders". I am delighted to provide a testimonial on the peer review process, editorial office support, and the overall quality of the journal. The peer review process at Brain and Neurological Disorders is rigorous and meticulous, ensuring that only high-quality, evidence-based research is published. The reviewers are experts in their fields, and their comments and suggestions were constructive and helped improve the quality of my manuscript. The review process was timely and efficient, with clear communication from the editorial office at each stage. The support from the editorial office was exceptional throughout the entire process. The editorial staff was responsive, professional, and always willing to help. They provided valuable guidance on formatting, structure, and ethical considerations, making the submission process seamless. Moreover, they kept me informed about the status of my manuscript and provided timely updates, which made the process less stressful. The journal Brain and Neurological Disorders is of the highest quality, with a strong focus on publishing cutting-edge research in the field of neurology. The articles published in this journal are well-researched, rigorously peer-reviewed, and written by experts in the field. The journal maintains high standards, ensuring that readers are provided with the most up-to-date and reliable information on brain and neurological disorders. In conclusion, I had a wonderful experience publishing in Brain and Neurological Disorders. The peer review process was thorough, the editorial office provided exceptional support, and the journal's quality is second to none. I would highly recommend this journal to any researcher working in the field of neurology and brain disorders.
Dear Agrippa Hilda, Journal of Neuroscience and Neurological Surgery, Editorial Coordinator, I trust this message finds you well. I want to extend my appreciation for considering my article for publication in your esteemed journal. I am pleased to provide a testimonial regarding the peer review process and the support received from your editorial office. The peer review process for my paper was carried out in a highly professional and thorough manner. The feedback and comments provided by the authors were constructive and very useful in improving the quality of the manuscript. This rigorous assessment process undoubtedly contributes to the high standards maintained by your journal.
International Journal of Clinical Case Reports and Reviews. I strongly recommend to consider submitting your work to this high-quality journal. The support and availability of the Editorial staff is outstanding and the review process was both efficient and rigorous.
Thank you very much for publishing my Research Article titled “Comparing Treatment Outcome Of Allergic Rhinitis Patients After Using Fluticasone Nasal Spray And Nasal Douching" in the Journal of Clinical Otorhinolaryngology. As Medical Professionals we are immensely benefited from study of various informative Articles and Papers published in this high quality Journal. I look forward to enriching my knowledge by regular study of the Journal and contribute my future work in the field of ENT through the Journal for use by the medical fraternity. The support from the Editorial office was excellent and very prompt. I also welcome the comments received from the readers of my Research Article.
Dear Erica Kelsey, Editorial Coordinator of Cancer Research and Cellular Therapeutics Our team is very satisfied with the processing of our paper by your journal. That was fast, efficient, rigorous, but without unnecessary complications. We appreciated the very short time between the submission of the paper and its publication on line on your site.
I am very glad to say that the peer review process is very successful and fast and support from the Editorial Office. Therefore, I would like to continue our scientific relationship for a long time. And I especially thank you for your kindly attention towards my article. Have a good day!
"We recently published an article entitled “Influence of beta-Cyclodextrins upon the Degradation of Carbofuran Derivatives under Alkaline Conditions" in the Journal of “Pesticides and Biofertilizers” to show that the cyclodextrins protect the carbamates increasing their half-life time in the presence of basic conditions This will be very helpful to understand carbofuran behaviour in the analytical, agro-environmental and food areas. We greatly appreciated the interaction with the editor and the editorial team; we were particularly well accompanied during the course of the revision process, since all various steps towards publication were short and without delay".
I would like to express my gratitude towards you process of article review and submission. I found this to be very fair and expedient. Your follow up has been excellent. I have many publications in national and international journal and your process has been one of the best so far. Keep up the great work.
We are grateful for this opportunity to provide a glowing recommendation to the Journal of Psychiatry and Psychotherapy. We found that the editorial team were very supportive, helpful, kept us abreast of timelines and over all very professional in nature. The peer review process was rigorous, efficient and constructive that really enhanced our article submission. The experience with this journal remains one of our best ever and we look forward to providing future submissions in the near future.
I am very pleased to serve as EBM of the journal, I hope many years of my experience in stem cells can help the journal from one way or another. As we know, stem cells hold great potential for regenerative medicine, which are mostly used to promote the repair response of diseased, dysfunctional or injured tissue using stem cells or their derivatives. I think Stem Cell Research and Therapeutics International is a great platform to publish and share the understanding towards the biology and translational or clinical application of stem cells.
I would like to give my testimony in the support I have got by the peer review process and to support the editorial office where they were of asset to support young author like me to be encouraged to publish their work in your respected journal and globalize and share knowledge across the globe. I really give my great gratitude to your journal and the peer review including the editorial office.
I am delighted to publish our manuscript entitled "A Perspective on Cocaine Induced Stroke - Its Mechanisms and Management" in the Journal of Neuroscience and Neurological Surgery. The peer review process, support from the editorial office, and quality of the journal are excellent. The manuscripts published are of high quality and of excellent scientific value. I recommend this journal very much to colleagues.
Dr.Tania Muñoz, My experience as researcher and author of a review article in The Journal Clinical Cardiology and Interventions has been very enriching and stimulating. The editorial team is excellent, performs its work with absolute responsibility and delivery. They are proactive, dynamic and receptive to all proposals. Supporting at all times the vast universe of authors who choose them as an option for publication. The team of review specialists, members of the editorial board, are brilliant professionals, with remarkable performance in medical research and scientific methodology. Together they form a frontline team that consolidates the JCCI as a magnificent option for the publication and review of high-level medical articles and broad collective interest. I am honored to be able to share my review article and open to receive all your comments.
“The peer review process of JPMHC is quick and effective. Authors are benefited by good and professional reviewers with huge experience in the field of psychology and mental health. The support from the editorial office is very professional. People to contact to are friendly and happy to help and assist any query authors might have. Quality of the Journal is scientific and publishes ground-breaking research on mental health that is useful for other professionals in the field”.
Dear editorial department: On behalf of our team, I hereby certify the reliability and superiority of the International Journal of Clinical Case Reports and Reviews in the peer review process, editorial support, and journal quality. Firstly, the peer review process of the International Journal of Clinical Case Reports and Reviews is rigorous, fair, transparent, fast, and of high quality. The editorial department invites experts from relevant fields as anonymous reviewers to review all submitted manuscripts. These experts have rich academic backgrounds and experience, and can accurately evaluate the academic quality, originality, and suitability of manuscripts. The editorial department is committed to ensuring the rigor of the peer review process, while also making every effort to ensure a fast review cycle to meet the needs of authors and the academic community. Secondly, the editorial team of the International Journal of Clinical Case Reports and Reviews is composed of a group of senior scholars and professionals with rich experience and professional knowledge in related fields. The editorial department is committed to assisting authors in improving their manuscripts, ensuring their academic accuracy, clarity, and completeness. Editors actively collaborate with authors, providing useful suggestions and feedback to promote the improvement and development of the manuscript. We believe that the support of the editorial department is one of the key factors in ensuring the quality of the journal. Finally, the International Journal of Clinical Case Reports and Reviews is renowned for its high- quality articles and strict academic standards. The editorial department is committed to publishing innovative and academically valuable research results to promote the development and progress of related fields. The International Journal of Clinical Case Reports and Reviews is reasonably priced and ensures excellent service and quality ratio, allowing authors to obtain high-level academic publishing opportunities in an affordable manner. I hereby solemnly declare that the International Journal of Clinical Case Reports and Reviews has a high level of credibility and superiority in terms of peer review process, editorial support, reasonable fees, and journal quality. Sincerely, Rui Tao.
Clinical Cardiology and Cardiovascular Interventions I testity the covering of the peer review process, support from the editorial office, and quality of the journal.
Clinical Cardiology and Cardiovascular Interventions, we deeply appreciate the interest shown in our work and its publication. It has been a true pleasure to collaborate with you. The peer review process, as well as the support provided by the editorial office, have been exceptional, and the quality of the journal is very high, which was a determining factor in our decision to publish with you.
The peer reviewers process is quick and effective, the supports from editorial office is excellent, the quality of journal is high. I would like to collabroate with Internatioanl journal of Clinical Case Reports and Reviews journal clinically in the future time.
Clinical Cardiology and Cardiovascular Interventions, I would like to express my sincerest gratitude for the trust placed in our team for the publication in your journal. It has been a true pleasure to collaborate with you on this project. I am pleased to inform you that both the peer review process and the attention from the editorial coordination have been excellent. Your team has worked with dedication and professionalism to ensure that your publication meets the highest standards of quality. We are confident that this collaboration will result in mutual success, and we are eager to see the fruits of this shared effort.
Dear Dr. Jessica Magne, Editorial Coordinator 0f Clinical Cardiology and Cardiovascular Interventions, I hope this message finds you well. I want to express my utmost gratitude for your excellent work and for the dedication and speed in the publication process of my article titled "Navigating Innovation: Qualitative Insights on Using Technology for Health Education in Acute Coronary Syndrome Patients." I am very satisfied with the peer review process, the support from the editorial office, and the quality of the journal. I hope we can maintain our scientific relationship in the long term.
Dear Monica Gissare, - Editorial Coordinator of Nutrition and Food Processing. ¨My testimony with you is truly professional, with a positive response regarding the follow-up of the article and its review, you took into account my qualities and the importance of the topic¨.
Dear Dr. Jessica Magne, Editorial Coordinator 0f Clinical Cardiology and Cardiovascular Interventions, The review process for the article “The Handling of Anti-aggregants and Anticoagulants in the Oncologic Heart Patient Submitted to Surgery” was extremely rigorous and detailed. From the initial submission to the final acceptance, the editorial team at the “Journal of Clinical Cardiology and Cardiovascular Interventions” demonstrated a high level of professionalism and dedication. The reviewers provided constructive and detailed feedback, which was essential for improving the quality of our work. Communication was always clear and efficient, ensuring that all our questions were promptly addressed. The quality of the “Journal of Clinical Cardiology and Cardiovascular Interventions” is undeniable. It is a peer-reviewed, open-access publication dedicated exclusively to disseminating high-quality research in the field of clinical cardiology and cardiovascular interventions. The journal's impact factor is currently under evaluation, and it is indexed in reputable databases, which further reinforces its credibility and relevance in the scientific field. I highly recommend this journal to researchers looking for a reputable platform to publish their studies.
Dear Editorial Coordinator of the Journal of Nutrition and Food Processing! "I would like to thank the Journal of Nutrition and Food Processing for including and publishing my article. The peer review process was very quick, movement and precise. The Editorial Board has done an extremely conscientious job with much help, valuable comments and advices. I find the journal very valuable from a professional point of view, thank you very much for allowing me to be part of it and I would like to participate in the future!”
Dealing with The Journal of Neurology and Neurological Surgery was very smooth and comprehensive. The office staff took time to address my needs and the response from editors and the office was prompt and fair. I certainly hope to publish with this journal again.Their professionalism is apparent and more than satisfactory. Susan Weiner
